Cor et Vasa Case Reports 1/2022


titulka_ico1-22.jpgCor et Vasa Case Reports
Svazek | Volume 5 • Číslo | Number 1
Únor | February 2022

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Refrakterní zástava oběhu na podkladě vysoce rizikové plicní embolie u mladého pacienta 

O. Sirotek, V. Pechman, M. Hromádka, A. Žídková, J. Baxa, R. Rokyta

Patients with pulmonary embolism leading to cardiac arrest usually have poor prognosis. Adequate treatment is essential. Besides anticoagulant and thrombolytic therapy we can employ circulatory and ventilatory support, mechanical circulatory support like venoarterial extracorporeal membrane oxygenation (V-A ECMO) and surgical or catheter embolectomy. The use of these therapeutic modalities could be connected with specific complications. We present a 17-year-old young man with out-of-hospital cardiac arrest where conventional resuscitation methods were not successful so patient was transported during ongoing cardiopulmonary resuscitation (CPR) to a regional ECMO centre. Bed-side echocardiography was very suspicious of pulmonary embolism. Unfractioned heparin was applied and the ECMO support was initiated. Computed tomography verified extensive bilateral pulmonary embolism with right ventricle dilatation. Patient’s hemodynamic status was getting worse so thrombolysis was administered. Severe complications have occurred and led to repeated surgical interventions. This case also demonstrates the necessity of multidisciplinary cooperation.

Thoracic aortic rupture associated with multiple aneurysms of medium-sized arteries: case report 

K. Rücklová, E. Honsová, P. Tomášek

Thoracic aortic disease is a rare but important cause of death that may affect young individuals. We present a case of a young man who died of thoracic aortic rupture associated with multiple aneurysms of medium-sized arteries. Possible causes of this multivascular pathology are discussed here with emphasis on potential genetic etiology and its implications for post mortem investigations including molecular autopsy and cardiogenetic counselling in the family.

Free-floating thrombus in the left atrium 

S. Rečičárová, M. Jonák.

A free-floating thrombus in the left atrium is a rare condition that usually occurs with mitral valve disease. We present a case of an 82-year-old woman with the free-floating left atrial thrombus which was found incidentally on the preoperative transesophageal echocardiogram in the patient with mitral valve disease and persistent atrial fibrillation. The patient has been on anticoagulation therapy for 15 years. We discuss different possibilities that led to the formation of the thrombus.

Anomalous origin of the left coronary artery from the pulmonary artery as a life-threatening condition 

N. Seredyuk, O. Babliak, A. Vytrykhovskyi, R. Petrovskyi, A. Matlah, Y. Vandzhura, O. Tsaruk, I. Grabas, O. Skakun, M. Bielinskyi, I. Tverdokhlib, M. Serediuk

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), also called Bland–White–Garland syndrome, is a rare congenital coronary artery abnormality that often manifests itself by chronic myocardial ischemia, angina during breastfeeding, myocardial infarction, sudden cardiac death. This article reports on the ALCAPA in an adult man. The patient complained of chest discomfort for a long time, a silent myocardial infarction was suspected. When he was 29 years old, he developed out-of-hospital cardiac arrest while exercising (treadmill at the gym) with successful electrical cardioversion and resuscitation. ALCAPA diagnosis was verified using computed tomography coronary angiography (CTCA). Left anterior minimally invasive thoracotomy was performed. Left coronary artery (LCA) trunk was ligated, cut, and sewed, distal LIMA-LAD anastomosis was made. Two weeks after the surgical correction a postpericardiotomy syndrome developed, which was successfully treated using methylprednisolone and ibuprophene.